Successful treatment of lung squamous cell carcinoma with envafolimab, a PD-L1 inhibitor combined with chemotherapy - a case report

Sep 30, 2026

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Case report from the iMDT Corner describes a 66-year-old male with stage IVB left upper lung squamous cell carcinoma and confirmed hepatic metastasis. After limited control with first-line pembrolizumab-containing chemotherapy, second-line gemcitabine plus cisplatin, endostar, and subcutaneous envafolimab was given. Follow-up CT showed marked reduction of the left hilar mass and relief of bronchial obstruction, with response maintained for over 6 months during envafolimab monotherapy.

LanguageEnglish

CategoryHealthcare

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Pages9

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Case Report: iMDT Corner Successful treatment of lung squamous cell carcinoma withenvafolimab, a PD-L1 inhibitor combined with chemotherapy: a case report Xin Sun1, Yu Tang1, Yue Zhu2, Jinrong Wei1, Xiaochun Zhang1, Atsushi Osoegawa3, Rossana Berardi4, Fumihiro Yamaguchi5, Haibo Cheng6 1Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, China; 2Department of Gynaecology and Obstetrics, Sheyang County People’s Hospital, Yancheng, China; 3Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Yufu, Japan; 4Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy; 5Department of Respiratory Medicine, Showa Medical University Fujigaoka Hospital, Yokohama, Japan; 6The First Clinical Medical College, Nanjing University of Chinese Medicine, Department of Oncology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, Nanjing, China Contributions: (I) Conception and design: X Sun; (II) Administrative support: X Zhang; (III) Provision of study materials or patients: X Sun; (IV) Collection and assembly of data: Y Zhu; (V) Data analysis and interpretation: X Sun, Y Zhu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Haibo Cheng, PhD. The First Clinical Medical College, Nanjing University of Chinese Medicine, Department of Oncology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210000, [China. Email: haibocheng@njucm.edu.cn](China. Email: haibocheng@njucm.edu.cn). Background: Metastatic non-small-cell lung cancer (NSCLC) represents a significant clinical challenge and is the leading cause of cancer-related death worldwide. Immune checkpoint inhibitors (ICIs), particularly those targeting the programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) pathway, have transformed the treatment of advanced-stage NSCLC; however, their efficacy varies, and optimal strategies following initial ICI failure remain undefined. Envafolimab, a novel humanized singledomain anti-PD-L1 antibody fragment fused to an Fc domain, is the first globally approved subcutaneous PD-L1 inhibitor. Its unique structure confers advantages in terms of tissue penetration and distribution compared to conventional monoclonal antibodies. Case Description: This report details the case of a 66-year-old male diagnosed with stage IVB (cT4N2M1c) squamous cell carcinoma of the left upper lung with confirmed hepatic metastasis. Initial immunohistochemistry revealed a tumor proportion score for PD-L1 ≥1%, prompting the following standard first-line therapy as per the guidelines: three cycles of albumin-bound paclitaxel [470 mg, day (d)1], carboplatin (568 mg, d1), and pembrolizumab (200 mg, d1). This regimen yielded inadequate disease control. Subsequently, second-line therapy comprising two cycles of gemcitabine (1.6 g, d1; 1.4 g, d8), cisplatin (40 mg, d1–3), endostar (30 mg, d1–4), and subcutaneous envafolimab (200 mg, d1) was initiated. Followup computed tomography (CT) imaging revealed a notable reduction in the left hilar mass and significant alleviation of the bronchial obstruction. This therapeutic response was sustained for over 6 months during envafolimab monotherapy maintenance without recurrence. Conclusions: This case shows the potential efficacy of envafolimab-based combination therapy in achieving a clinically significant and durable response for a patient with metastatic squamous NSCLC (sq-NSCLC) who showed disease progression on first-line pembrolizumab-containing chemotherapy. It suggests that envafolimab warrants consideration as a viable treatment option in this setting, particu

FAQs

What patient condition and stage are described in this case report?

The report describes a 66-year-old male with stage IVB squamous cell carcinoma of the left upper lung and confirmed hepatic metastasis.

Why was the treatment changed after the initial therapy?

The first-line pembrolizumab-containing chemotherapy regimen produced inadequate disease control, prompting second-line treatment.

What was the observed outcome after adding envafolimab?

Imaging showed a notable reduction of the left hilar mass and significant alleviation of bronchial obstruction, and the response was sustained for over 6 months during envafolimab maintenance.

Sep 30, 2026

Uploaded by Rhys